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General NPI Number Information
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NPI Number | 1699238824
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Entity Type | Organization
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Legal Business Name | PREMIER PSYCHOLOGY OF INDIANA, LLC
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Dates
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Enumeration Date | 04/14/2019
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Last Update Date | 04/14/2019
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Provider Practice Location Address
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Address Line | 11350 N MERIDIAN ST STE 300
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City | CARMEL
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State | IN
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Zip | 46032-3531
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Country | US
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Telephone | 317-414-0466
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Fax |
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Provider Business Mailing Address
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Address Line | 1347 CLAY SPRING DR
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City | CARMEL
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State | IN
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Zip | 46032-9753
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Country | US
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Telephone | 317-414-0466
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Fax |
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Authorized Official
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Title or Position | CLINICAL PSYCHOLOGY/OWNER
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Name | JENNIFER GODAR
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Credential | PSY.D.
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Telephone | 317-414-0466
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 103TC0700X
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Taxonomy Name | Clinical Psychologist
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License Number |
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License Number State |
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